Diagnosis and management of giant cell arteritis: Major review

Abstract

Giant cell arteritis is a medical emergency because of the high risk of irreversible blindness and cerebrovascular accidents. While elevated inflammatory markers, temporal artery biopsy and modern imaging modalities are useful diagnostic aids, thorough history taking and clinical acumen still remain key elements in establishing a timely diagnosis. Glucocorticoids are the cornerstone of treatment but are associated with high relapse rates and side effects. Targeted biologic agents may open up new treatment approaches in the future.

Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners

“…Other historical clues that can be helpful include polymyalgia rheumatica, weight loss, fatigue, and abdominal pain due to mesenteric ischemia [ 6 , 7 ]. Laboratory evaluation should include the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count including platelet count [ 8 , 9 ]. A list of the most commonly abnormal lab values for the disease process are listed in Table 2 .…”

“…A list of the most commonly abnormal lab values for the disease process are listed in Table 2 . These laboratory tests are elevated at diagnosis in most patients and crucial to monitoring disease activity [ 8 , 9 ]. However, 20% of patients have normal laboratory testing [ 6 ].…”

“…However, 20% of patients have normal laboratory testing [ 6 ]. CRP is much more sensitive than ESR, but the combination of all three is the most helpful and also guides management [ 6 , 8 , 9 ]. Acute serum amyloid A (A-SAA) is less readily available but also highly sensitive [ 9 ].…”

“…CRP is much more sensitive than ESR, but the combination of all three is the most helpful and also guides management [ 6 , 8 , 9 ]. Acute serum amyloid A (A-SAA) is less readily available but also highly sensitive [ 9 ]. Magnetic resonance imaging (MRI) with and without gadolinium of the orbits and temporal artery may be very helpful [ 5 , 6 , 8 , 9 ].…”

“…Acute serum amyloid A (A-SAA) is less readily available but also highly sensitive [ 9 ]. Magnetic resonance imaging (MRI) with and without gadolinium of the orbits and temporal artery may be very helpful [ 5 , 6 , 8 , 9 ]. A CT scan does not pick up the vasculitis but an ultrasound of the temporal arteries may [ 8 ].…”